brief interventions –using motivational interviewing ruler tool readiness ruler = a self...
TRANSCRIPT
Brief Interventions – Using
Motivational Interviewing
Introduction, Spirit, Principles
Tim Guimond, MD, MSc, FRCPC
Centre for Addiction and Mental Health
Consulting Psychiatrist, Casey House
March 2011
Outline
• Intro and welcome
•Motivation
– Interpersonal effects
• Foundation of MI
– Spirit
– Principles
– Demonstration
– Traps to avoid
Exercise 1
Behaviour change – Influence of others
Instructions
Others can influence our choice to change in ways that are positive, or negative.
• Write down:– What is something someone else wants you to do, but you don’t want to?
• Think of the last time this person spoke to you about making this change
• In your small group, discuss the following questions:
Influence of others
How has the influence of the other person
impacted your choice thus far?
1. Who started the conversation?
2. What has the other person said to you
about this change?
3. What did you think and feel in response?
4. Were you more or less motivated by the
exchange?
Interpersonal effects
• Did anyone have an example
where they left the discussion
with increased motivation?
• If so, what did the other person
say/do?
Exercise 2
Behaviour change – Readiness ruler
Readiness ruler tool
Readiness ruler = a self evaluation tool
to assess where an individual is at with
respect to the importance,
confidence and readiness to make a change, on a scale of 1 - 10, one
being not at all, to ten being 100 %.
Can be applied as an evaluation tool
pre and post discussion, or as a check
in comparison over time.
Instructions
What is something you have been thinking about doing, but haven’t started yet?
Apply readiness ruler to your potential change:
• How important is it to you to make this change?
• How confident are you that you can make this change?
• How ready are you to make this change?
Exercise 3
Behaviour change – Pros and cons
Saunders’ Law of Behaviour
Change
People only change when the
pain of change is less than the
pain of staying the same.
The pros and cons of change
Enhancing our understanding of
the pros and cons of change is
essential for successful behaviour change.
•What is something you used to
do, that you would like to start doing again?
4 way window tool
1
PROSCurrent Situation
4
PROSPotential Change
2
CONSCurrent Situation
3
CONSPotential Change
4 way window tool
1
What do you gain by not doing this activity?
4
What do you enjoyabout this activity?
2
What do you lose by not doing this?
3
What would it cost you to start again?
What is motivation?
““The most prevalent common sense view of motivation is that people do things because they perceive them as being better in some way than not doing them.” (West, 1989)
“Motivation is the sum of the factors that influence an individual to behave in a certain way.” (Saunders, 1994)
Ambivalence
• The natural response of anyone who is challenged about a behaviour over which they are ambivalent, is to argue the counter position. In other words, they will defend why they don’t want to change.
• Good news. The reverse can also occur.
• How we get a person to argue for change is the fundamental question that the MI process answers.
MI defined
“Motivational interviewing is a collaborative, person-centredform of guiding to elicit and strengthen motivation for change.”*
MI is a technique that works with, rather than against, a client’s ambivalence about behaviourchange.
*Miller, W.R. & Rollnick, S. (2009) Ten things that Motivational Interviewing is not.
Behavioural and Cognitive Psychotherapy, 37, 129-140.
Break
MI Overview
SPIRIT
Principles
Skills
Change Talk
Commitment Talk
Behaviour Change
Autonomy
Collaboration
Evocation
Resist the righting reflex
Understand motivation
Listen
EmpowerOpen ended questions
Affirm
Reflections
SummariesDesire
Ability
Reason
NeedI will…
Evidence from Social Psychology
• Experiments were held where
people were assigned to
‘sides’ of a debate on issues they had no opinion on, and
then asked later about their
opinions on this matter.
•What do you think happened?
Video demonstration
What Motivational Interviewing Sounds Like
MI Overview
SPIRIT
Principles
Skills
Change Talk
Commitment Talk
Behaviour Change
Autonomy
Collaboration
Evocation
Resist the righting reflex
Understand motivation
Listen
EmpowerOpen ended questions
Affirm
Reflections
SummariesDesire
Ability
Reason
NeedI will…
MI spirit – ACE
•Autonomy vs. authority– Affirms the person's right and capacity for self-direction
•Collaboration vs. confrontation– A partnership that honours the person’s experience and perspective
• Evocation vs. education– Resources and motivation are presumed to be within the person
MI Review
SPIRIT
Principles
Behaviour Change
Autonomy
Collaboration
Evocation
R
U
L
E
MI guiding principles- RULE
• Resist the righting reflex
• Understand the person's motivation (s)
• Listen to the person
• Empower the person
Resist the righting reflex
• Practitioner’s have a powerful
desire to set things right, to heal, to
prevent harm, to promote well
being
– there are 2 sides of ambivalence:
a) reason to stay the same and
b) reason to change
– Paradoxical Effect: natural
response of a person is to argue the
other side of the ambivalence
Understand the motivation
• Be interested in the person’s own concerns, values and motivation(s)– i.e. explore why the person attended the appointment
• Person’s own reason to change, not yours, will motivate behaviourchange
• Note: Takes less time to investigate why a person would want to make a change, and how they might do it, versus convincing them that they should change
Listen to the person
• Active listening
•Complex skill
• Quality listening is an essential
ingredient of good care
• Involves empathic interest
• Demonstrated through accurate reflections
• Critical to the MI process
Empower the person
• Help person explore their ambivalence, and their ability to change
• Instill hope
• Provide affirmations
• Increased outcome measures when person is an active participant in their own choice, decision, treatment, etc.
MI Overview
SPIRIT
Principles
Skills
Change Talk
Commitment Talk
Behaviour Change
Autonomy
Collaboration
Evocation
Resist the righting reflex
Understand motivation
Listen
EmpowerOpen ended questions
Affirm
Reflections
SummariesDesire
Ability
Reason
NeedI will…